Provider Demographics
NPI:1235153230
Name:PIZZATO, MICHAEL STEVEN (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:STEVEN
Last Name:PIZZATO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 531400
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46253-1400
Mailing Address - Country:US
Mailing Address - Phone:317-682-2020
Mailing Address - Fax:317-920-7551
Practice Address - Street 1:321 E NORTHFIELD DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-2415
Practice Address - Country:US
Practice Address - Phone:317-852-6065
Practice Address - Fax:317-852-2468
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000866A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200933000Medicaid
INE46567Medicare UPIN
INM400038391Medicare PIN
IN342100AMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER